New blog post by Helen Smith: Quality Improvement for NHS Board members

Helen Smith talks to us about the importance of having a good understanding of QI at board level. Helen Smith is Medical Director and Consultant Forensic Psychiatrist at Devon Partnership NHS Trust.
“At the AHSN our QI team deliver training to Boards across the patch. Each and every Board we have worked with demonstrates a commitment to quality, and it has been interesting to see how many of the non-executive directors have brought skills to Boards that align well with the development we are delivering.
The NHS has always had a stated focus on improving quality, so what needs to be different now? Most people know WHAT needs to be improved in their organisation; the dilemma is often HOW to make the improvements in order to maximise both success and its sustainability. There is a public and staff desire for improvements to be delivered at an increased pace, hence the need to focus on the ‘how’ in more detail.
There are 5 key areas for Boards to consider as they work to improve their QI expertise.
1. Strategy. Does the strategy clearly articulate the quality aspirations of the organisation’s ambition? Does it translate from the Board to the clinical interfaces? Does each member of that organisation understand their role in delivering the strategy? One of the best known examples of this is when a janitor at NASA was asked by President Kennedy what his job was: “To help put a man on the moon, Mr President”.
2. Organisational infrastructure. Does each corporate department work in a way that supports QI? Do you recruit people with the values and skills to deliver QI? Do you train people at every level to deliver QI? Does your performance team deliver data that allows you to understand any variations, so that the whole organisation can see what needs to be improved and how improvement efforts are progressing? Does your finance team understand QI, and how it might be involved in financial planning?
3. Do you have the capability within your organisation to deliver QI, from Board through every clinical and non-clinical team? How are you going to develop this now and in the future? Do you understand what QI capability looks like for each role in your organisation?
4. Capacity. Organisations need to create the capacity and time for people to commit to quality improvement despite the current climate of austerity. Boards need to feel confident that investments made will pay dividends in both quality outcomes for people using services and also from a financial perspective.
5. Culture. The culture can be considered to be what we all get up to when we think no one is looking; perhaps one of the most challenging aspects to get right. Making many of the changes described will help to change the culture of an organisation, through the way it works. Leadership behaviours are crucial to enabling a culture that supports QI. Every senior person, from the Board to local managers and senior clinical staff, needs to pay attention to the quality improvement that is being implemented. They need to be able to ask questions that recognise the team’s success, and enable that team to progress their project along its journey to completion. Such attention needs to be a priority; successful QI organisations expect senior staff to spend at least half a day a week working with teams in this way.
Curiosity may have killed the cat but not the dedicated quality improver! Luckily there are increasing numbers of organisations demonstrating great QI, such as East London FT in Mental Health and Salford FT in Physical Health to name but two.”
SW AHSN is happy to provide board development support to understand how to cultivate a culture of QI and safety across organisations. Please contact William.Lilley@swahsn.com for more details.